UnitedHealth Says it’s “Fixing Things” — and it’s Got a 23-step Checklist to Prove it

With input from CNBC and Bloomberg.

UnitedHealth Group dropped the first set of findings Friday from a massive independent audit of how it runs key parts of its business — and it’s promising changes, receipts included.

The health-care giant said it’s rolling out 23 ongoing “action plans” meant to track and implement recommended improvements across three areas. About 65% of those steps should be done by the end of 2025, and the whole list is supposed to be finished by the end of March next year. UnitedHealth says its internal audit and advisory services team will be watching over the rollout.

The timing isn’t subtle. Private insurers are in full reputation-rebuild mode after a wave of public anger over denials, delays, surprise costs and the general maze that is the US health-care system. UnitedHealth owns UnitedHealthcare — the biggest insurer in the country — which makes it a lightning rod for that frustration. Whether this audit helps with the trust deficit is still an open question.

UnitedHealth said two outside firms handled the first round:

• FTI Consulting looked at UnitedHealthcare’s Medicare Advantage operations, including how it does risk assessment (basically: how sick patients are rated, which affects payments) and how it handles care services management policies and processes.
• Analysis Group reviewed Optum Rx, UnitedHealth’s pharmacy benefit manager (PBM), focusing on whether manufacturer discounts and rebates are being accurately collected and passed along to clients.

UnitedHealth commissioned the review back in July — the same day it confirmed it was facing Department of Justice investigations tied to Medicare billing practices. The audit was also one of new CEO Steve Hemsley’s first big moves after he took over in May following Andrew Witty’s abrupt exit.

In a letter released Friday, Hemsley framed the audits as a transparency play — basically: here’s how we operate, and here’s how we’ll tighten it up.

UnitedHealth said both firms described its policies as “robust” and generally sound — even “industry leading” in some areas — while still flagging places to improve.

Optum Rx:
Analysis Group said Optum Rx has a “comprehensive” framework for managing manufacturer discounts and pointed to at least 25 controls meant to reduce the risk of miscalculating, under-collecting or delaying discount distribution. It didn’t find deficiencies needing corrective action, but it did suggest upgrades — like strengthening escalation processes when drugmakers don’t pay or disputes drag on. One of UnitedHealth’s action plans: build a formal policy for handling those situations.

UnitedHealthcare / Medicare Advantage:
FTI found UnitedHealth scored better than peers on some Medicaid and Medicare measures, but also pointed to familiar pain points: slow authorization decisions, documentation problems, and the need to better address issues raised in regulatory audits.

UnitedHealth says more findings are coming:

• A review of medical records tied to diagnosis codes is expected in the first quarter.
• A report on how the company builds what it calls “evidence-based medical policy” is expected by mid-year.

UnitedHealth shares are down more than 35% this year after the company suspended its 2025 forecast amid rising medical costs, leadership turmoil, and continued scrutiny of its Medicare Advantage business. The company is also coming off a rough 2024 that included a major cyberattack and intense public blowback after the murder of UnitedHealthcare CEO Brian Thompson.

Bottom line: UnitedHealth is trying to show it’s listening — and that it’s willing to put changes on a deadline. Now it has to prove those “action plans” actually translate into faster decisions, clearer processes, and fewer patients feeling like the system is rigged against them.